目的 提高审方准确性,促进临床合理用药,提高静脉用药的安全性、有效性、经济性.方法 静配药师通过科伦PIVAS协同管理系统,完善自定义药品字典的审方规则,利用智能+人工相结合的审方模式配合多种干预方法促进临床合理用药.以胃肠外科为代表,回顾性统计2019年5月至2020年10月的普通用药医嘱,分阶段逐一分析,对不合理医嘱进行统计和归类,并就不合理性原因进行统计和分析.结果 39447条医嘱中不合理医嘱共计2877份,占全部医嘱的7.29％,包括药品剂量超量,给药频次不当等几类.可以看出通过静配药师不间断的干预,医嘱不合理率整体呈下降趋势.结论 静配药师在规范临床用药方面发挥了重要作用.静配药师借助智能化审方系统构建审方规则,提高医嘱审核准确度,加强与临床的沟通,规避用药风险,提高药学服务质量.

目的:验证现有的早产儿氟康唑群体药动学模型对外部数据的预测准确性,并对给药剂量进行优化,为早产儿的个体化给药提供参考.方法:通过文献检索,提取国内外已发表的关于氟康唑的早产儿群体药动学模型信息.收集30例使用氟康唑的早产儿临床资料和血药浓度数据,采用拟合优度法、可视化预测检验法(visual predictive check,VPC)、正态化预测分布误差(normalised prediction distribution errors,NPDE)外部评价已发表模型的拟合预测效果.选择拟合度最佳的模型,采用贝叶斯最大后验概率法计算得到氟康唑在我院早产儿群体中的药动学参数和变异值.采用蒙特卡洛模拟,评价和优选最佳给药方案.结果:本研究最终纳入2项氟康唑的早产儿群体药动学模型.外部验证结果显示Kim等建立的韩国早产儿模型更符合中国早产儿的药动学特征.模拟结果显示,对于MIC≥5 mg·L-1的念珠菌感染,氟康唑现行的推荐剂量3～12mg·kg-1抗感染治疗成功率低于90％,需要提高给药剂量.结论:本研究通过外部验证确认了适合我国早产儿的氟康唑群体药动学模型,临床可利用此模型和致病菌药敏试验结果指导个体化用药.

目的 分析婴儿胆汁淤积性肝病(ICH)的病因学特征.方法 收集2014年1月至2018年7月武汉儿童医院消化内科收治的婴儿黄疸病例资料,符合美国儿科学会推荐ICH诊断标准为入组标准.回顾性分析入组病例的病因及临床特征.结果 符合入组标准共271例ICH.主要病因考虑为感染性疾病110例、遗传代谢性疾病19例、胆道系统结构异常81例、药物相关性肝炎3例、全胃肠外营养相关性胆汁淤积共12例及先天性甲状腺功能低下7例,其他病因未知39例.感染性疾病中,发病率最高的为巨细胞病毒感染,共61例.遗传代谢疾病19例中,发病率最高为Citrin蛋白缺乏所致ICH12例,其他病因有:Alagille综合征4例、先天性肉碱缺乏2例,进行性家族性肝内胆汁淤积症1例.胆道结构异常疾病中,经胆道造影手术确诊先天性胆道闭锁有55例,32例行葛西手术治疗;先天性胆总管囊肿17例,胆道发育不良有9例.结论 感染性因素组以巨细胞病毒感染为主,血生化特征以不同程度胆红素指标升高及肝酶指标轻中度升高.胆道系统疾病以先天性胆道闭锁为主,表现为持续黄疸不能消退及排浅黄色或陶土样大便,营养状况差,胆囊B超提示胆囊形态异常,胆囊收缩功能差,存在不同程度的肝硬化,部分病例接受葛西手术治疗病情有所缓解.遗传代谢因素组,以Citrin缺乏为主,该病临床特征有黄疸、腹胀、生长发育迟缓、凝血相及甲胎蛋白指标异常等.ICH的病因和发病机制比较复杂,其诊断和治疗都相当棘手.

2019年新型冠状病毒肺炎疫情特殊时期,减少纸质病案的污染是病案管理的重点,其突出问题是患者和医师需要签字的病历内容必须在病区产生并收回保管.为解决这个问题,探讨仅针对未使用电子签名的基层医院减少纸质病历在隔离病区的产生,进一步从源头遏制纸质病历在隔离病区受到污染.新冠肺炎患者住院病历的书写应更加注重基础资料的收集、病程的完整记录以及特殊病案的标识,保证特殊病案资料的完整准确.为减少纸质病案在隔离病区的流通和污染,医院可在与上级部门沟通申报的情况下对新冠肺炎病历签名的时效性和签名授权予以调整,采用医师补签、患者授权代签或患者免签等方案.传染病诊治中临床注重防与控,其病案中的签名可特事特办.疫情的出现也督促应进一步加大医院信息化的建设,基层医院应适当加大力度应用电子签名,大型综合医院应向更为科学严谨的无纸化病案发展.

目的 了解伏立康唑致肝毒性的临床特点、治疗与转归.方法 检索国内外数据库中伏立康唑致肝毒性的报道,比较伏立康唑治疗前后相关检测指标,分析伏立康唑致肝毒性的临床特点和预后.采用药物性肝损伤因果关系评价法(RUCAM评分量表对伏立康唑与肝毒性关联性进行评价.结果 共纳入文献病例16例,其中男13例,女3例;平均55岁,50%患者年龄>65岁;单独使用伏立康唑3例,伏立康唑合并使用质子泵抑制药6例;14例患者肝毒性发生在应用伏立康唑后20 d内;伏立康唑肝毒性主要临床表现为全身不适、乏力、恶心、呕吐、四肢肌肉酸痛、皮肤黄染等;实验室检查主要表现为转氨酶升高.发生肝毒性后,2例患者减量继续用药,其余14例患者停药或换药治疗;13例病情缓解;11例患者于停药20 d内症状消失.RUCAM量表关联性分析结果显示,16例患者肝毒性均与伏立康唑相关.结论 伏立康唑致肝毒性的发生涉及患者年龄、性别、原患疾病、药物相互作用等多种因素,临床应用时需加强监测,以减少不良反应.

OBJECTIVE To make a comprehensive evaluation of the clinical application of tigecycline,and provide references for the rational application and monitor program of this drug.METHODS Tigecycline used in our hospital from June 1,2013 to May 31,2016 was investigated,and its clinical use by the hospital centralized monitoring method was evaluated.The patient characteristics,medications,dosage regimes,treatment plans,combination treatment and pathogen test results,clinical outcomes and safety were summarized and analyzed.RESULTS The total number of cases was 1 415,including 63.96％ males,63.25％ were 18-69 years old;72.93％ (1 032) patients were treated by medication mainly against lung,abdominal and soft tissues infections.The top 3 pathogens were Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli.The mainly irrational uses of tigecycline included no indications medication,improper dosages,long course of treatment and irrational combination use.The total ADR number was 27 (1.91 ％),all were considered mild.The irrational use of tigecycline showed a decreased trend after the centralized monitoring and management measures were improved.CONCLUSION The clinical use of tigencycline in our hospital is basically reasonable,but there's still several irrational medication which still need special management to prompt the rational medication for tigecycline.

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

Objective:To assess the clinical use of dezocine injection. Methods:The application of dezocine injection in the in-patients during December 2015 and November 2016 in a hospital was statistically analyzed and evaluated from indications, dosage, treatment course and combined drug use, etc. Results:A total of 12847 patients with the age range of 0-97 and the average age of (49 ± 15. 6) years old were treated with dezocine injection. The top three departments using dezocine injection were orthopaedics (12. 70％), hand surgery (10. 30％) and liver surgery (9. 39％). Totally 132 patients were with overdose(1. 03％), and mainly in cardiac surgery. The medication course of 1042 patients was more than one week(8. 11％), which was too long, while most of the pa-tients were with tumor. Conclusion:The clinical use of dezocine injection in the hospital is basically reasonable. However, clinicians still need more training to minimize the risks involved in the process of clinical medicine application.